• E K Aasvang, I E Luna, and H Kehlet.
• Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø 2100, Denmark The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark eske.kvanner.aasvang.01@regionh.dk.
• Br J Anaesth. 2015 Dec 1; 115 (6): 861-6.

AbstractThis narrative review updates the recent advances in our understanding of the multifactorial pathogenesis for reduced postdischarge physical and cognitive function after fast-track surgery, using total hip and knee arthroplasty as surgical models. Relevant factors discussed include the surgical stress responses and potential methods for controlling postsurgical inflammation, pain, and cognitive dysfunction. The continuation of moderate to severe pain in up to 30% of patients for 2-4 weeks calls for better understanding of the underlying mechanisms and development of effective multimodal opioid-sparing analgesic regimens. The need for the development of effective physiotherapy programmes on a patient-specific basis is discussed, along with the need for optimal assessment of postoperative function to guide rehabilitation. Other relevant factors discussed include the role of orthostatic intolerance, sleep disturbances, and blood management, and specific patient populations at risk for adverse outcomes, including psychiatric disorders, to identify and guide future interventions for optimizing functional postdischarge outcomes after fast-track surgery. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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